New nursing schools struggle

Reforms are under way to help Nevada programs, students make the grade

Nursing student Jill Petersen puts an oxygen mask on a medical mannequin Wednesday in a Nevada State College lab in Henderson. Eighty percent of the school’s first-time candidates for nurse licensing passed the exam in 2008, meeting the state’s minimum requirement for nursing schools after three years of falling short.

NURSING PROGRAM CHANGES

• Opened a simulation lab where students work with high-tech mannequins that exhibit “symptoms” of illnesses.

• Provided new and expanded practice tests.

• The school experienced high turnover in the past, with four permanent or interim nursing directors since its inception and some faculty leaving mid-semester. But no full-time nursing faculty members have left since the current director started in July.

NEVADA STATE COLLEGE

• Began requiring applicants to earn a 3.0 grade-point average in nursing prerequisites instead of a 2.5.

• Began requiring students to review material using programs created by nursing education resource company MEDS Publishing that ask questions of the type students see on the licensure test.

• Revised curriculum.

TOURO UNIVERSITY

• Began using MEDS Publishing products to reinforce students’ knowledge.

• Placed increased emphasis on encouraging students to take the licensure test soon after graduation.

• Revised curriculum.

UNIVERSITY OF SOUTHERN NEVADA

• Began requiring cumulative finals in courses instead of a midterm and final dealing with separate material.

• Began requiring applicants to complete a test assessing academic skills. Began giving applicants credit in the admissions process for high science grades.

• Interviewed former students to identify the program’s perceived strengths and weaknesses.

SOURCE: Each college provided its own information.

Nevada’s nursing shortage is one of the nation’s worst. So it should come as good news that four nursing schools launched over the past six years are now producing about a quarter of the state’s prospective registered nurses.

These new programs have struggled, however, to adequately prepare students for the licensure exam they must pass to obtain employment in nursing.

In 2008, nearly half the graduates of Apollo College and the University of Southern Nevada who took the test for the first time failed.

Statistics were less grim for Touro University and Nevada State College. Eighty percent of first-time candidates passed, the minimum the State Nursing Board requires for teaching programs to obtain full approval. Touro’s pass rate the previous year, the first in which its graduates took the exam, was a dismal 57 percent. Nevada State College had missed the 80 percent goal for three consecutive years.

Across the country, new schools often have trouble meeting standards. But in Arizona and California, few have logged pass rates as low as Nevada’s newest programs have.

Debra Scott, the Nevada Nursing Board’s executive director, says Apollo and the University of Southern Nevada — whose nursing programs opened in 2007 and 2006, respectively — should view graduates’ performance on the licensure test as problematic. Pass rates, she says, are an indicator of a program’s quality.

“It is the board’s role to protect the public, which includes all citizens of Nevada,” Scott says. “If students are not getting quality education, they (may) not be quality nurses.”

Prompted by those concerns, board staff will, beginning this year, visit campuses every 18 months to gauge whether programs with provisional approval are following policies and supporting students.

High failure rates on the licensure exam can pose problems for hospitals, which hire recent graduates with interim permits to work as nurses. Most facilities commit to keeping these employees even if they fail the test, but must shift them to different positions if that happens, says Vickie Wright, the Nevada Hospital Association’s nurse executive.

Nationwide, about 87 percent of first-time candidates passed the exam in 2008. In Nevada, more-established programs at six public colleges and universities had rates of at least 84 percent last year, though some struggled to meet goals in the recent past.

Problems at some of the new nursing schools include high turnover in faculty and administration (Touro and Apollo have each had four permanent or interim nursing directors); inexperienced teachers; troubles with curriculum; lax admission requirements; and students who put off taking the National Council Licensure Examination. Officials at some nursing schools say that candidates who test soon after graduation are more likely to pass.

Apollo reported to the state nursing board in April that after discovering one clinical instructor’s license was expired and another did not have at least a bachelor’s degree in nursing, the school was tracking license expiration dates and verifying new hires’ credentials.

Nevada State, which offers a two-year nursing program and an accelerated one-year program, reported to the nursing board in October that just 19 of 40 students entering the regular program in spring 2007 were still enrolled. A nursing school task group is focusing on retention.

Directors of all four new programs say improvements are on the way.

Apollo opened a lab in 2008 where students can work with high-tech dummies that exhibit “symptoms” of illnesses. The University of Southern Nevada modified entrance requirements, asking applicants to complete an exam assessing their academic aptitude, and awarding them for high marks in science courses.

Both the programs are tailoring students’ preparation for the licensure test toward individual needs.

At Nevada State College, similar changes are apparently paying off. The school’s pass rate for first-time test takers has ticked upward every year since 2005, when it was 62.5 percent.

The college increased nursing admissions standards a few years ago and recently began requiring students to use a review program that asks questions of the type they will see on the national licensure exam.

After Nevada State missed the state board’s 80 percent target for two straight years, a consultant suggested a temporary enrollment cap, more faculty development, and curriculum revisions including increasing students’ training in adult health nursing. The college adopted the recommendations.

Touro also retooled its curriculum and began using new remediation tools to reinforce students’ knowledge. Teachers have increased efforts to “emphasize critical thinking and application of content, rather than regurgitation,” the school informed the nursing board in a written report in October. In that report, Touro said students were memorizing to pass exams rather than studying to understand concepts.

Despite challenges, 17 of 21 spring 2008 nursing graduates said in a survey that they agreed, strongly agreed or somewhat agreed that they would choose Touro again if they could start over.

Cory Hatch, the elected president of Touro’s student nurses association, says he is satisfied with the school, even though other students complain broadly about the quality of their education. Hatch lauds faculty members for maintaining an “open-door” policy.

His comments echo those of Anna Friday, who graduated from Apollo in November 2008 and passed the licensure exam on her first try. Friday, now a nurse at North Vista Hospital, says Apollo had a “family feel.”

She says high turnover in faculty and administration bothered some classmates, but “I succeeded because of Apollo. (Teachers) put in the effort, they offered time before or after school.”

Robyn Nelson, health and human services dean and acting nursing director at Touro, says she wishes the nursing board would consider more than just first-time pass rates. “Often,” she says, “students have anxiety the first time they take the exam.”

In Nevada, candidates can sit for the licensure test three times before having to undergo remediation. Touro’s pass rate for November 2007 graduates rises to 97 percent when those who failed once but successfully repeated the test are included.

Pass rates for the first classes to finish at Apollo and the University of Southern Nevada also exceed 90 percent when repeat candidates are wrapped in.

Some states, such as Arizona, which expects 75 percent of graduates from each program who take the exam within 12 months of graduation to pass on the first try, have standards less stringent than Nevada. Nursing boards across the country use the first-time pass rate to judge colleges.

“It’s important because that’s probably the most direct reflection of the quality of the program” in terms of preparing the student for the national licensure exam, says Pam Randolph, the Arizona State Nursing Board’s associate director for education and evidence-based regulation. Repeat test takers’ success, in contrast, often reflects remediation they seek outside of school, she says.